Bullying Report

Bullying as defined by IC 20-33-8-0.2 means overt, unwanted, repeated acts or gestures, including verbal or written communications or images transmitted in any manner (including digitally or electronically), physical acts committed, aggression, or any other behaviors that are committed by a student or group of students against another student with the intent to harass, ridicule, humiliate, intimidate, or harm the targeted student and create for the targeted student an objectively hostile student environment that: 1) places the targeted student in reasonable fear of harm to the targeted student’s person or property;
2) has a substantially detrimental effect on the targeted student’s physical or mental health;
3) has the effect of substantially interfering with the targeted student’s academic performance; or
4) has the effect of substantially interfering with the targeted student’s ability to participate in or benefit from the services, activities and privilege provided by the school.

Name of Targeted Student:

Today's Date:

School:

Name of Person Making Report: (Reports may be anonymous or by self, teacher/staff, parent/guardian, volunteer, etc.)